| NPI | 1750773297 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3926) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 29492) |
| 208D00000X General Practice (Licence: NE 29492) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2025-01-06 |